We have a variety of National
Quality Forum ( NQF ) - endorsed NHSN clinical quality measures used in
CMS ’ public reporting and payment programs ; they are in use currently in the CMS program ; the AU measure , which is our most recent measure , is not yet in use but it is however the measure that most closely approximates the automation that we are envisioning for NHSN ’ s future .”
— Daniel Pollock , MD
It had a compelling story ; it seemed like a good thing to do ; but it was not evidence based .”
As we have seen , the SENIC study converted a movement into a mandate . Following closely on the IOM ’ s To Err is Human report was an influential series of investigative articles on HAIs published infections published in The Chicago Tribune which underscored the findings of the IOM report on the major public health effects of HAIs and criticized hospitals for failing to prevent these infections and keeping secret the scope of the problem . Both the IOM report and articles in the mainstream media triggered a lively discussion about HAI prevention and spurred action by consumers and state legislatures . In 2002 , Illinois , Florida , Missouri and Pennsylvania passed laws to mandate that healthcare facilities publicly report HAIs . Proponents of the legislation argued that healthcare facilities would finally begin to take real steps toward preventing HAIs if they were made to be transparent .
Capitulation reached a fevered pitch in 2005 and 2006 with the publication of two studies on CLABSI prevention in intensive care units that collaborated to reduce these infections by implementing a relatively simple set of interventions . The results of the studies were striking , in that CLABSIs were reduced by roughly 65 percent .
As Dixon ( 2011 ) notes , “ Increasing awareness of the scope of the HAI problem , coupled with the recognition that a substantial portion of these infections could be prevented , galvanized even more consumers and policy makers to take action . Many other state legislatures began to debate and pass laws to mandate the public reporting of HAIs . In recognition of the growing interest in so-called public reporting , CDC worked with the Healthcare Infection Control Practices Advisory Committee ( HICPAC ) to develop recommendations to help guide future legislation . These laws have now become widespread . Federal lawmakers also have taken up the HAI issue . In 2008 , as part of the larger deficit-reduction act , Congress mandated that the Center for Medicare and Medicaid Services ( CMS ) stop giving hospitals increased payments for the care of patients with HAIs . CMS worked closely with CDC to identify HAIs that were ‘ reasonably preventable ’ to support implementation of this requirement . In 2010 , Congress incorporated HAI prevention into the Value-Based Purchasing program of the Affordable Care Act . CMS has elected to implement the requirement by requiring national public reporting of HAIs , beginning with CLABSIs in 2011 .”
In the years since , the CDC advocated for legislative mandates on HAI reporting and prevention , and in return , numerous states that required reporting specifically stipulated that healthcare facilities use the CDC ’ s NHSN reporting platform . Likewise , CMS mandated data reporting to the NHSN , swelling the numbers of enrolled hospitals significantly .
But mandatory reporting has not always been universally embraced for its ability to increase IP & C department resourcing , transparency and accountability , especially among some healthcare institutions and among chronically overworked infection preventionists who argue that it has resulted in a diversion of limited IP & C department resources and in some instances encourages the gaming of infection rates to ensure Medicare reimbursement and local merit awards / compensation goals are attained . ( Barnes , 2017 )
HAI surveillance and reporting efforts are impacted by numerous factors , but as public health expert Julie Reagan notes , “ Infection preventionist ( IP ) workload has always been an issue ,” she says . “ In advisory meetings , the burden on hospitals ( time and money ) is always a big consideration . The IP turnover is huge ! You ’ d think it would be a nice job to have , as it pays well and has a more life-amenable work schedule . Yet , IPs frequently say they are unhappy and turnover between hospitals is more than expected . Politics was more of an issue from 2008 to 2010 when states were forcing the issue of state legislation . Note , HAI prevention advancements took a big hit during the Trump Administration . Little attention was given to improvements and there was this undercurrent of anti-science sentiment . Liability issues are always a concern ; however , litigation is difficult because it ’ s very hard to prove that an HAI was the hospital ’ s fault . I ’ m sure most HAI cases are settled , but that ’ s just my opinion .”
As for what she believes is on the horizon for HAI reporting , Reagan says that activity relating to state legislation is quiet currently . “ When you have an influx of state laws such as we had from 2007 to 2010 , the wave tends to die out ,” she explains , noting that , “ The federal government will continue to adapt its regulations for acute-care settings and long-term regulations are definitely needed . Long-term care , I believe , should and will be the next focal point , and there will be new COVID reporting for nursing homes . Antibiotic resistance / stewardship programs also will be on the rise .” Specifically , she points to the links between HAI and antibiotic resistance program activities and the population-based accreditation standards and measures for health departments .
Dealing With All That Data
The increase in the provision of clinical care in the era of COVID-19 , ambitious surveillance , and mandated reporting generate a massive amount of data , and clinicians are still struggling in some aspects to harness these data and leverage them for process improvement . In mid-April , the Society for Healthcare Epidemiology of America ( SHEA ) presented its virtual Decennial Day 2021 meeting ; among the plenary sessions was the presentation , “ Data for Action : The Future of Surveillance for Healthcare-Associated Infections and Antimicrobial Resistance ,” in which experts addressed key issues impacting how data can be used to advance the infection prevention and healthcare epidemiology agenda in hospitals .
In this plenary session , Daniel Pollock , MD , a medical epidemiologist and the surveillance branch